We evaluated the added value of lung window in non-contrast computed tomography (CT) of suspected body packers or stuffers. Forty suspected drug mules who were referred to our tertiary toxicology center were included. The final diagnosis of drug mule was based on the detection of packs in stool examination or surgery. Non-contrast CT scans were retrospectively interpreted by two blinded radiologists in consensus before and after reviewing the lung window images. The diagnostic performance of abdominal window scans alone and scans in both abdominal and lung windows were subsequently compared. Seven body packers and 21 body stuffers were identified. The sensitivity, negative predictive value (NPV), and diagnostic accuracy of scans in detection of drug mules (either drug packers or stuffers) raised from 60.7, 52.1, and 72.5 to 64.2, 54.5, and 75.0 %, respectively, with a more number of packs being detected (114 vs. 105 packs). In the body packers group, the diagnostic performance of both abdominal windows scans and combined abdominal and lung windows scans were 100 %. In the body stuffers group, the sensitivity, NPV, and diagnostic accuracy of scans increased from 47.6, 52.1, and 55.0 to 52.3, 54.5, and 57.5 %, respectively, after the addition of lung windows. Reviewing the lung window on non-contrast abdominal CT can be helpful in detection of drug mules.
The performance of control charts with estimated parameters in Phase II depends on the accuracy of parameter estimation in Phase I. Estimation accuracy depends on the amount of data. Simulation results show that no realistic number of Phase I samples is available to ensure that the in‐control performance of control charts with estimated parameters is close to cases where the parameters are known. In this paper, the bootstrapping method is applied to adjust the control and warning limits of c‐charts with adaptive sampling schemes, such as variable sample size, variable sampling intervals, and variable parameters. The adjusted charts guarantee that the in‐control average adjusted time to signal is more than a certain amount with a predefined probability. In addition, the performance of the adjusted adaptive c‐charts is compared with the commonly used approach to design adaptive c‐charts.
Background:Imaging is the mainstay of diagnostic criteria in tuberculosis (TB) diagnosis, especially in children; however, the exact role of chest X-ray (CXR) and thoracic CT scan (TCT) still remains controversial. The aim of this study is to compare digital chest X-ray and thoracic CT scan in childhood tuberculosis. Materials and Methods: In this retrospective comparative study, 38 children under 15 years old with proved diagnosis of TB who were admitted to Massih Daneshvari hospital during 2010 to 2012. Digital chest X-ray and spiral thoracic CT was performed before starting medication. Results: Direct smear for acid-fast bacillus was positive only in 38%. Positive tuberculin skin test was seen in 51% of the cases. Chest X-ray was normal in 36.8% of children, while CT scan was negative only in 21%. Overall sensitivity of thoracic CT scan and chest X-ray were 78.9% and 63.2%, respectively which show no significant difference. CT scan detected lymphadenopathy, nodule/nodular infiltration, collapse and pleural effusion/ thickening significantly better than chest X-ray; however, there was no significant difference between CXR and TCT in detection rate of consolidation/ground glass opacity, bronchiectasis, cicatricial volume loss and cavity/abscess. Conclusions: This study proposed that investigation of children suspicious of tuberculosis by digital chest X-ray is still of great value. It seems that thoracic CT scan in children suspected of tuberculosis infection can be limited only to investigation of complications in selected patients.
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